Attention A T users. To access the menus on this page please perform the following steps. 1. Please switch auto forms mode to off. 2. Hit enter to expand a main menu option (Health, Benefits, etc). 3. To enter and activate the submenu links, hit the down arrow. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links.

Please ask your question or describe the issue in detail in the space below. If the question, or issue, is about a disability, please be specific as to the type of disability(ies) or the issue(s). If you have multiple claims for benefits pending and want the status, please tell us which claim this is about.

Question * Required Please do not enter your name, file number, or social security number in the question box to the right. You will be asked this information in the fields below.

Topic, Sub-topic, and Inquiry Type?

Please Select a Topic * Required

Please select a Topic

Route to State To ensure we route your submission to the proper office for reply, please select the state where your regional office is located.

To ensure we route your submission to the proper office for reply,
please select the state where your regional office is located.

Medical Center List To ensure we route your submission to the proper office for reply, please select the proper location (i.e. where you received care, or nearest facility):

To ensure we route your submission to the proper office for reply,
please select the proper location (i.e. where you received care, or nearest facility):

Since we have more than one million records in the IRIS system, it looks for an EXACT match of all identifying information, including your first name, last name, suffix, and email address. If you have submitted an inquiry previously, please be sure to enter your name and email address exactly as you did before to avoid problems finding your record.

Preferred Response Type * Required How Would You Like Us To Respond To Your Inquiry?

How Would You Like Us To Respond To Your Inquiry?

Form of Address * Required

First Name * Required

Middle Initial If you have no middle initial, please leave blank

If you have no middle initial, please leave blank

Last Name * Required If your name includes a suffix such as Jr, Sr, IV, etc., please enter in separate Suffix field below.

If your name includes a suffix such as Jr, Sr, IV, etc., please enter in separate Suffix field below.

Inquirer Suffix Only if Applicable

Only if Applicable

Email Address For security and privacy reasons, we use your email address as a primary identifier. If you have submitted an inquiry previously, please use the same email address you entered before.

For security and privacy reasons, we use your email address as a primary identifier. If you have submitted an inquiry previously, please use the same email address you entered before.

It's not required, but providing your Email Address may dramatically reduce the time it takes to process your request, by helping us better match your information.

Daytime Phone

Country * Required

Street

City

State

Zip code

Dependent information?

Dependent Relation to Veteran

Dependent Form of Address

Dependent First Name

Dependent Middle Initial If the dependent has no middle initial, please leave blank.

If the dependent has no middle initial, please leave blank.

Dependent Last Name If last name name includes a suffix such as Jr, Sr, IV, etc., please enter in separate Suffix field below.

If last name name includes a suffix such as Jr, Sr, IV, etc., please enter in separate Suffix field below.

Dependent Suffix Only if Applicable

Only if Applicable

Dependent Email Address Email address, if any, must be different from the email addresses entered in section(s) above; otherwise, leave blank.

Email address, if any, must be different from the email addresses entered in section(s) above; otherwise, leave blank.

Although not required, providing the Dependent Email address may reduce the time it takes to process your request by helping us to match identifying information.

Dependent Daytime Phone

Dependent Country

Dependent Street

Dependent City

Dependent State

Dependent Zip code

Veteran information?

Veteran Form of Address

Veteran First Name

Veteran Middle Init If the veteran has no middle initial, please leave blank.

If the veteran has no middle initial, please leave blank.

Veteran Last Name If last name includes a suffix such as Jr, Sr, IV, etc., please enter in separate Suffix field below.

If last name includes a suffix such as Jr, Sr, IV, etc., please enter in separate Suffix field below.

Veteran Suffix Only if Applicable

Only if Applicable

Veteran Country

Veteran Street

Veteran City

Veteran State

Veteran Zip Code

Veteran Email Address Email address, if any, must be different from the email addresses entered in section(s) above; otherwise, leave blank.

Email address, if any, must be different from the email addresses entered in section(s) above; otherwise, leave blank.

Although not required, providing the Veteran Email address may reduce the time it takes to process your request by helping us to match identifying information.

Veteran Phone Number

Veteran's Branch of Service, Social Security Number, Claim Number and/or Service Number, and Service Dates (if known):

Branch of Service If more than one branch of service, enter last branch.

If more than one branch of service, enter last branch.

Veteran SSN (No Hyphens) If your claim number is the same as your Social Security Number, enter it here (type all numbers, no hyphens).

If your claim number is the same
as your Social Security Number,
enter it here (type all numbers, no hyphens).

Veteran Service Number (If Service Number is other than your SSN or claim number, enter it here. Enter 12 digits, numbers only; no hyphens, spaces, etc.)

(If Service Number is other than your SSN or claim number, enter it here. Enter 12 digits, numbers only; no hyphens, spaces, etc.)

Vet Claim Num(other than SSN) Claim Number format must be: 6, 7 or 8 numeric digits. Enter numbers only. Do not include 'C' or other letters, spaces, or periods.

Claim Number format must be: 6, 7 or 8 numeric digits. Enter numbers only. Do not include 'C' or other letters, spaces, or periods.

Veteran Date of Birth (MM-DD-YYYY)

(MM-DD-YYYY)

Date Entered Active Duty (MM-DD-YYYY)

(MM-DD-YYYY)

Date Released Active Duty (MM-DD-YYYY)

(MM-DD-YYYY)

Providing as many of these identifying pieces of data as possible will reduce the time it takes to process your request, by helping us better match information.

Please click on the "Submit" button JUST ONE TIME. There may be a delay as long as 25 seconds while your information is routed electronically to the appropriate office. Again, please click only once. Processing is complete when your screen changes to an acknowledgement from VA that your message has been received.

The Paperwork Reduction Act of 1995 requires us to notify you that this information collection is in accordance with the clearance requirements of section 3507 of the Paperwork Reduction Act of 1995. We may not conduct or sponsor, and you are not required to respond to, a collection of information unless it displays a valid OMB number. We anticipate that the time expended by all individuals who must complete this form will average ten (10) minutes. This includes the time it will take to read instructions, gather the necessary facts and fill out the form. This collection of information is intended to fulfill the need identified by the Department of Veterans Affairs (VA) to categorize your question, complaint, compliment, or suggestion and collect the necessary information to respond to it. Results will be used to automatically route your inquiry to the appropriate person in the VA, which will help ensure that you receive a response in a timely manner. Use of this form is voluntary and failure to participate will have no adverse effect of benefits to which you might otherwise be entitled.